Covid-19 Vaccine for University Students
The objective of this survey is to count the number of students to be vaccinated at the Covid-19 vaccination center which will be established in the University of Ruhuna.

Please read the following instructions before responding to this survey.

1. This survey is only applicable for any university student who didn't get single dose of any Covid-19 vaccine.
2. Always provide honest and accurate information.
3. We will use this information only for this task.

Finally, we would really appreciate your kind response to this survey to success of this national task.
Name of your University *
Name of your Faculty *
Your name with initials *
Your national identity card (NIC) number *
Your university registration number *
Address of your current residence *
Grama Niladari Davison (GND) of your current residence *
District of your current residence *
Nearest MOH office to your current residence *
Your email address *
Your contact number (mobile number preferred) *
I here by declare that I didn't get single dose of any Covid-19 vaccine *
必填
Do you have any allergies to vaccines or drugs?
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